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Dual Care Plan for 2026

Medicare and HMSA QUEST (Medicaid) – Better Together

HMSA Akamai Advantage® Dual Care (PPO D-SNP) coordinates your Medicare and HMSA QUEST (Medicaid) benefits at no additional cost.

  • A $125 monthly allowance for over-the-counter (OTC) health products, food, and home utilities.1
  • $0 dental cleanings, exams, X-rays, fillings, dentures, and more.
  • $0 eye exam and $300 annually toward eyeglasses and contact lenses.
  • $0 generic prescription drugs.
  • Silver&Fit® fitness center membership and home fitness program.

With this plan, you’ll also get a health coordinator who can help you with your health care.

 wcagcolheader HMSA Akamai Advantage Dual Care (PPO D-SNP)

Monthly premium
The amount you pay each month.

You must continue to pay your Part B premium if Medicaid or another source doesn’t already pay for it.

Extra Help, or Low Income Subsidy, can help pay for prescription drugs and monthly premiums. Find out more.

 $0
In-network maximum out-of-pocket
The most you pay each year for Medicare-covered medical services from in-network providers. 		 $9,250
2026 Star Rating Coming soon

Provider directory
Medical Benefits2
  You Pay
Annual medical deductible $0
Inpatient hospital care3 $0 up to 90 days
Skilled nursing facility3 $0 up to 180 days
Primary care provider office visit $0
Specialty care provider office visit $0
Annual wellness visit $0
Outpatient hospital and ambulatory surgical center services3 $0
Ambulance, includes ground and air ambulance $0
Emergency care $0
Urgent care $0
Diagnostic services, labs, and imaging3 $0
Medicare Part B drugs3 $0
Medicare Part B insulin drugs3 $0
Medical equipment and supplies3 $0
Supplemental Vision Benefits
  You Pay
Routine eye exam (once a calendar year) $0
Contact lenses and eyeglasses (frames and lenses) $0
Plan pays up to $300 every calendar year. 
Vision Provider Directory English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF] 
Supplemental Dental Benefits

Diagnostic and preventive dental services:

  • Two oral exams every calendar year
  • Two cleanings every calendar year
  • One set of bitewing X-rays every calendar year
  • One set of full mouth X-rays or a panoramic X-ray every five calendar years
  • Two fluoride treatments every calendar year
 $0

Comprehensive dental services:

  • Four extractions every calendar year
  • Two fillings every calendar year
  • One impacted tooth removal per tooth per lifetime
  • One root canal every calendar year
  • One crown every calendar year
  • One deep cleaning per quadrant every 24 months
  • Two therapeutic cleanings every calendar year
  • One full mouth debridement every three calendar years
  • One complete denture or partial denture per arch (upper/lower) every five calendar years
  • One immediate denture per arch (upper/lower) per lifetime
  • Two denture adjustments and/or repairs per arch (upper/lower) every calendar year
  • One denture rebase or reline per arch (upper/lower) every calendar year
 $0
Dental Provider Directory Dental Provider Directory
English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF]
Other Supplemental Benefits and Programs

Over-the-counter (OTC) Health Products, Food, and Home Utilities Allowance1

You’ll receive an HMSA Extra Benefits debit card with an allowance for over-the-counter health products. If you’re eligible, you'll also be able to use the allowance for healthy food and home utilities. You can purchase covered products at select retail stores or through mail order delivery at HMSAExtraBenefits.com or by calling 1-800-790-6019.

For more information, visit hmsa.com/ExtraBenefits.

 $0
Plan pays $125 a month
Over-the-counter (OTC) Health Products and Healthy Food Catalog Over-the-counter (OTC) Health Products and Healthy Food Catalog [PDF]
Fitness — Silver&Fit Healthy Aging and Exercise Program
A membership to a participating fitness center, one Home Fitness Kit per year, Well-Being Coaching, and more. 		 Fitness Center Membership
$0/month for standard fitness center, $30-$580/month for premium fitness center

Home Fitness Kit
$0
One Home Fitness Kit per calendar year

Well-Being Coaching
$0
Telehealth services
Includes HMSA’s Online Care 		 $0
Health education
Learn more		 $0
Drug Benefits
  You Pay
Annual drug deductible
Extra Help, or Low Income Subsidy, can help pay for prescription drugs and monthly premiums. Find out more.		 $615
Does not apply to Tier 1 and Tier 2 drugs, insulin, and most Part D vaccines. 
Initial coverage stage
Until you’ve paid $2,100 out of pocket for Part D drugs.
30-day supply from retail pharmacies 
Tier 1 - Preferred Generic $0
Tier 2 - Generic $0
Tier 3 - Preferred Brand
Tier 4 - Non-preferred Drug
Tier 5 - Specialty 		 For generic drugs: $0, $1.60, or $5.10.
For all other drugs: $0, $4.90, or $12.65.
Copayments for drugs may vary based on the level of Extra Help you get. 
100-day supply from mail-order pharmacy 
Tier 1 - Preferred Generic $0
Tier 2 - Generic $0
Tier 3 - Preferred Brand
Tier 4 - Non-preferred Drug
Tier 5 - Specialty 		 For generic drugs: $0, $1.60, or $5.10.
For all other drugs: $0, $4.90, or $12.65.
Copayments for drugs may vary based on the level of Extra Help you get. 
Catastrophic coverage stage
After you’ve paid $2,100 out-of-pocket for Part D drugs. 		 $0 
Most Part D vaccines $0
Pharmacy Find a pharmacy
Prescription Drugs List (Formulary)
See if your prescription drugs are covered and search for lower-cost alternatives.
Resources and Plan Materials
Summary of Benefits Summary of Benefits
English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF]
Annual Notice of Changes Annual Notice of Changes
English [PDF] | Chinese [PDF] | Ilocano [PDF] | Korean [PDF] | Vietnamese [PDF]
Evidence of Coverage
Member Resources Learn more

1 The Food and Home Utilities allowance is a special supplemental benefit available only to chronically ill members with eligible chronic conditions, including diabetes, high blood pressure (hypertension), high cholesterol (hyperlipidemia), cardiovascular and other heart disorders, and stroke. Other conditions may be eligible. For the full list of eligible chronic conditions, see hmsa.com/ExtraBenefits-DualCare. All applicable eligibility requirements must be met before the benefit is provided. Not all members qualify. This benefit is only available on HMSA Akamai Advantage Dual Care (PPO D-SNP).

2 Because you get Medicaid assistance, you pay nothing for HMSA Akamai Advantage Dual Care (PPO D-SNP) premium or Medicare-covered medical services as long as you follow the plans’ rules for getting care.

3 For some services, your doctor or other network provider may request prior authorization. Please contact us for more information.

HMSA Disclaimer

  • This plan information is effective Jan. 1, 2026.
  • Every year, Medicare evaluates plans based on a 5-star rating system.
  • HMSA Akamai Advantage® Dual Care is a PPO D-SNP plan with a Medicare contract and is a state of Hawaii Medicaid Managed Care Program. Enrollment in HMSA Akamai Advantage Dual Care depends on contract renewal.
  • Benefit amounts listed are based on using HMSA participating providers.
  • Out-of-network/non-contracted providers are under no obligation to treat HMSA Akamai Advantage members except in emergency situations. To see if we’ll help pay for an out-of-network service, you or your provider can ask us for a pre-service organization determination before you receive the service. Please call Customer Relations or see your Evidence of Coverage for more information, including the share of your costs for out-of-network services.
  • To enroll in this plan, you must be eligible for Medicare and be enrolled in HMSA QUEST (Medicaid).
  • You must continue to pay your part B premiums unless Medicaid or another third party pays your Part B premium.